Method and system for providing adaptive rule based cognitive stimulation to a user

ABSTRACT

A method and system for providing evolving, highly variable, long-term on-going cognitive stimulation over a broad spectrum of cognitive domains. The user is presented with a series of entertaining audio/visual activities customized for the user, based on the user&#39;s life experience and cognitive level, each activity providing stimulation in one or more cognitive domains. The activities themselves and their level of challenge may change, in real time, over both the short- and the long term, varying in relation to current and historical user response patterns, creating an experience that remains engaging, with on-going use, over a period of months or years.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application claims the benefit under 35. U.S.C. 119(e) ofProvisional Application Ser. No. 60/748,326, entitled Method andApparatus for Providing Cognitive Stimulation.

BACKGROUND OF THE INVENTION

For the majority of the population, cognitive abilities decline withincreasing age, significantly reducing quality of life. Studies indicateongoing cognitive stimulation can mitigate this decline. They alsosuggest that the degree of mitigation increases with increased frequencyand duration of such stimulation.

Systems and methods have been developed to test and train cognitiveabilities. However, these systems make use of simple, repetitive tasksas testing and training stimuli, such as comparing the speed of twomoving circles presented on a computer screen as taught in U.S. Pat. No.6,632,174 to Breznetz. Although such tasks may be used to evaluate andtrain specific low-level cognitive abilities, they lack the variability,ecological validity, and entertainment value necessary to encourage andmaintain long-term use and interest and without long-term use, theirreal-world therapeutic value is limited. Thus, there is a continuingneed for endeavors that not only train low-level cognitive abilities,but do so in a way that is entertaining and relates to the real world toencourage long-term use.

SUMMARY OF THE PRESENT INVENTION

Briefly stated, the present disclosure describes an interactivecognitive stimulation system and method, designed to engage individualsin fun and challenging cognitive activities and exercises that willimprove their quality of life and, in the case of non-demented seniors,slow or possibly prevent the onset of dementia. To ensure a high levelof user interest, and to maximize real world relation, it engages user's(the term user and patient may be used interchangeably) in complex andever-changing interactive, cognitive exercises which draw on real-worldskills and subject-matter, and which are matched to each user's specificcognitive abilities, background, and interests. To further encouragecontinued and future participation, the format in which the exercisesare presented is fun, entertaining, and, most importantly, unlike atedious and laborious test.

Before a user's first session, an administrator (typically in anassisted living or senior care facility) or family member fills out ashort “User Data” questionnaire for that user usually using aweb-enabled application. In a stand-alone home application, the userdata is entered usually by way of a keyboard, either a computer keyboardor a virtual keyboard appearing on a computer monitor (touch screen).Answers to the questionnaire provide the basis of obtaining generallytwo types of information: demographic information and cognitiveinformation, related exclusively to the user. An embodiment of thedisclosure (system) uses the demographic information, including suchitems as date-of-birth, gender, language, culture, education, professionand likes and dislikes, to select appropriate content data from a storeddata base, presenting the user only activities relevant to his/herbackground, interests and age. Cognitive information is then used to setthe initial levels of challenge of exercises presented to the user intheir first session.

Providing each user with a unique program tailored to his specificabilities, interests and experience requires the identification of thespecific user prior to the start of each session. Facial recognitiontechnology has been adapted to accomplish this goal. To begin a session,the user sits facing a touch screen, presses a notated button on thefirst screen to commence operation of an identification process. Abutton represents a notated or identified portion of the screen that theuser contacts to identify his input, selection or response. This signalsthe built-in digital camera to take the user's picture. The systemsearches its database for a picture that matches the user's picture. Inthe most common scenario, when a match is found, the user isautomatically logged in. In certain arrangements, where for example thesystem is dedicated solely to a single user, normally in a homeenvironment, the mere act of turning the system on, satisfies the useridentification process.

After confirming the user's identity, the user commences a session.During the session, the user participates in activities and exercisesaddressing six cognitive domains: long-term memory, short-term memory,calculation, language, visuospatial, and critical thinking, allinteracting through the touch screen interface. When a user answers aquestion he/she receives immediate verbal, audio and video feedback, andvoice encouragement.

If a user answers a question, puzzle or game “correctly,” the user moveson to the next exercise. However, if an answer is “incorrect,” the userreceives encouraging verbal feedback and direction, which eventuallyresults in the user being guided to the correct answer. In this context,it is very important to appreciate that the user never ‘fails’ oranswers “incorrectly,” but rather nevertheless, receives self esteemsupporting positive reinforcement and encouragement.

If a user does not answer a question within a time representative ofhis/her normal response expectation, the user is prompted to “take aguess, if the user is unsure of the correct answer.” If after twoprompts, the user still doesn't respond, the user is directed to thenext exercise after a conciliatory transition, such as for example,“This one is really tough. Let's try something else.”

If a user consistently misses questions for a particular cognitivedomain or takes an inordinately long time to answer questions, thesequence of inquiries is adjusted to give the user easier questions forthat domain. This prevents feelings of failure and frustration thatcould lead users to quit, but in stead, promotes a sense of success,building feelings of accomplishment, self-confidence and self-esteem.Similarly, if the user answers all questions for a particular cognitivedomain correctly and at a fast pace, the inquiries are adjusted to givethe user more difficult questions more appropriate to his/her mentalcapabilities in that domain. Users will often receive non-challengingand entertaining optional rewards in the form, for example, of a movieor music clip. Over time, the user in a care facility environment orthose users connected to a central office via the internet may alsoreceive more tangible rewards and acknowledgements of theiraccomplishments through the mail.

Throughout the session, the user's response patterns are recorded andare used to update the user's mental status settings by domain. Themental status data provides the basis for the system undertakesstatistical analysis and send alerts regarding changes in patterns ofuser performance. A significant decline in a user's performance (e.g.speed and/or accuracy of response) could indicate a possible change inmedical condition including a stroke or an adverse drug interaction. Thesystem can be programmed, with the permission of the user, to send analert via email to the user's caregivers, physicians and family membersif it detects such declines.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an illustration of a block diagram of the general componentsof a system to provide adaptive rule based cognitive stimulation to auser according to an example embodiment of the present invention;

FIG. 2 is an illustration of a hierarchy of components of a show whichincludes sessions, events and screens in accordance with an embodimentof the present invention;

FIG. 3 is a flow chart to determine initial system tasks based upon thenature of the user, in accordance with an embodiment of the presentinvention;

FIG. 4 is a flow chart illustrating the creation of cognitive profilesof the user, in accordance with an embodiment of the present invention;

FIG. 5 is a flow chart illustrating the initialization of a user'scurrent show environment, in accordance with an embodiment of thepresent invention;

FIG. 6 is a flow chart illustrating the sequence of event occurrencesand interaction with a user, in accordance with an embodiment of thepresent invention;

FIG. 7 is a flow chart illustrating the determination of the next ruleto apply, in accordance with an embodiment of the present invention;

FIG. 8 is a flow chart illustrating the determination of the next eventto apply, in accordance with an embodiment of the present invention;

FIG. 9 is an illustration of a block diagram of system hardwarecomponents in accordance with an embodiment of the present invention; inaccordance with an embodiment of the present invention;

FIGS. 10 a to 10 z is an illustration of an example session including asequence of events, queries, and system feed back to the user, inaccordance with an embodiment of the present invention; and

FIG. 11 is a flow chart illustrating the adjustment of the user'scognitive ability in a cognitive domain, in accordance with anembodiment of the present invention.

DETAILED DESCRIPTION

FIG. 1 is an overall simplified block diagram of an example embodimentof the system of the present invention. Stimulator 100 is microprocessorbased and is configured to process information, namely User Data forinclusion and update of a User Profile and Content data. In the presentembodiment, the device uses information contained within variousdatabases to interact with the user. The databases that are representedin FIG. 1 are: Events Rule Database (104), which contains the variousrules used to decide when and how events are to be displayed to theuser, further described below; User Demographic Profile database (108),which contains the information from the general profile of the user(such as native language, date of birth, likes and dislikes, etc.);Events database (112), which contains the list of information on eachevent (like Hidden Words in FIGS. 10T-10X, representing the entireevent); User Cognitive Profile database (116) which has the userinformation relating to their cognitive levels and mental status(further described below); Event Screens database (120) which containsthe individual screens in each event (example, each individual screen inHidden Words shown in FIGS. 10T, 10U, 10V, and 10X); User Last ShowEnvironment database (124), where information on the last various eventsthe user has seen is stored; Event Screen Elements database (126), whichcontains the various elements of an event screen (example, buttongraphics, video clips, pictures, etc); and User Response Database (138),where all the responses to the events shown the user are stored. TheStimulator 100 includes a number of operations that perform functionsnecessary to interact with users, namely: an Interfacer (130), and anEvaluator (134). Depending on the event screen selected (based on rulesdescribed below), the Interfacer (130) retrieves all the relevant visualand audio cues that comprise that event screen, such as button graphics,movie clips, pictures, etc.

The system provides the described information from the Event ScreenElements database 126, and presents it to the user through the touchscreen monitor (132A) and/or Speakers (132B). The user then responds bymeans of touch screen monitor (132A) monitor, and those responses goback through the stimulator 100, to the Interfacer (130), and then tothe evaluator (134). The evaluator (134) processes the user responses,and provides the processed responses to the User Response database(138). The evaluator (134), from the user's response, determines whetherthe user is ready for a “more difficult” event, or should receive an“easier” event or maintain the same level of event difficulty incontinuing with the presentations. The evaluator (134) is alsoresponsible for providing the audio cues to the user depending on theuser's response, such as “that's right!” or “try again!” The stimulator100 also provides user response information to the User CognitiveProfile database (116) and the User Last Show Environment database(124). During use, these databases that receive information from thestimulator 100 will build upon and update the user profile as well asadd additional information that the device uses in future interactionswith that user.

The User Response Database provides information it has received to anoperation called the Analyzer (142), which analyzes the user's response.While operations undertaken in the Evaluator (134) occurs in real-time,the Analyzer (142) typically processes information during nonuseintervals or during user sleep time. The Analyzer undertakes checkingthe user's responses for any possible signs indicative of problemsregarding the user's health. Depending upon the results of the analysis,the Analyzer (142) will either communicate to the user with an Alert(144) which provides emergency information to caregivers, physiciansand/or family members, or communicates with a Report (146) tocaregivers, physicians and/or family members

The Stimulator 100 initiates a session as shown in FIG. 3 at step 300.As will be described in more detail later regarding FIGS. 10A-10E, thesystem using stored photos and facial recognition technology, attemptsto identify the user. In doing so the system determines, by way of theuser profile data, whether to commence further operations depending uponwhether a new user or existing user is participating in the session. Inthe event a new user is detected then an assessment at step 302commences. The assessment retrieves first the user's demographicinformation, then the user's cognitive information from thequestionnaire. If an existing user is detected then an initializefunction is undertaken at step 304. Initialization first retrieves theuser's demographic information from the questionnaire, then retrievesthe user's cognitive information from the User Cognitive ProfileDatabase 108 continually revised during previous user's sessions. Uponcompletion of either assessment at 302 or initialize at step 304 astimulate function at 306 is undertaken.

An embodiment of the present invention utilizes two different kinds ofdata: User Data and Content Data. Initially, the user will provide “UserData” that is basically the user profile, representing information aboutthe user that can affect how the system interacts with the user, andcreates a user profile that is constantly being updated throughcontinual user interaction. In a preferred embodiment, the user profileinformation is gathered via an Internet link (a remote application). Itis a compilation and representation of the users' recorded experienceover several months and even years using the system and method describedherein. The initial user “baseline” information includes demographicinformation about the user, which is filled in by a questionnaireanswered either by the user or a caregiver, which may include, forexample, but is not limited to name, date of birth, country of origin,language (first language/other language spoken/language preferred),residence history, hobbies, vocation history, special interest areas,family member's names and their relationship to the user, visionlimitations, and hearing limitations. User data also includes thecognitive functional level of the user, which details the cognitiveability, or Metal Status (MS) of the user, described as Stage 1(L1-normal high functioning), Stage 2 (L2-normal), Stage 3 (L3-normalbrain aging), Stage 4 (L4-mild cognitive impairment), and Stage 5(L5-mild to moderate dementia). Any references to a user's “stage,” willmean the level of their cognitive ability.

Content Data

Content data, which is independent of user's recorded experience, maytake the form of general information inquiries, recognition and problemsolving exercises, such as for example, completing puzzles and therewards may take the form of audio-visual recognition aimed at providingre-enforcing and motivational encouragement to the user. FIG. 2 is arepresentation showing the hierarchical structure of the content dataand its subparts. A show 200 represents the entire user's experiencewhich can last over several months or years. This show 200 may consistof any number of session 202s (i.e. 202A, 202B, etc.), one or more perday. A session 202 represents user experience with the system in onesitting, which may last minutes to hours. For example, referring to FIG.10, the entire Figure is considered one session. A session 202 mayconsist of any number of event 204s (i.e. 204A, 204B, 204C, 204D, etc.),which represents the smallest “unit” of a user's experience of thedevice during a session. Event 204 may consist of a singlestimulus-response interaction (typically one screen) or multiplestimulus-response interactions (multiple screens). This can include apresentation of a “reward” (movie and music clips, trivia, fun facts,photos) in response to a “correct” user answer.

There are a variety of event 204 types, which include but not beinglimited to: a demographic questionnaire, Login (user authentication),Main Title (an A/V presentation that displays every session, typicallyjust after the login event), Volume-Adj (a series of screens to allowthe user to adjust the volume of the speakers or headphones to theirpreferred level), Orientation (a quick audio/visual review of how to usethe system), Review (an A/V of high points from the users last session202), News (an Event presenting something involving current news),Question (an Event presented in question format, requiring a singleresponse), Story (an event presented in story format, which may involvemultiple user stimulus/response interactions), Puzzle (an event thatacts like a well-known puzzle format, like Tic-Tac-Toe), PhysEd (anEvent designed to lead the user through physical exercises), Motivation(an A/V presentation designed to improve the users outlook or motivatethe user), Entertainment (an A/V presentation just for fun).

Again referring ahead to FIG. 10, an event would consist of thepresentations illustrated in panels 10H-10J, 10K-10L, 10M-10S, 10T-10X,and 10Y-10Z. An Event 204 may consist of one or more event screen 206s(i.e. 206A, 206B, 206C, etc.). These event screens are what the useractually sees and interacts with. An event screen may consist of variousevent screen elements such as audio from System Speakers (132B) (i.e.music, sound effects), graphic (i.e. images, illustrations, line art),and/or video from touch screen 132A (i.e. movie clips, animations) thatalso interacts with the user and aids with the user stimulation process.These are illustrated in FIG. 10, with the graphic, photos, and movieclips seen in each individual panel.

The system can be set up to function in a user's home, medical facility,senior care community, community center, therapeutic center, senior daycare center and any similar area. The preferable set up of the system isfor the user to be positioned facing the touch screen 132A, so that theCamera (131) can focus on their face. The Camera 131 preferablypositioned at the top of the screen will scan the user's face, and usefacial recognition technology to identify the user based on a previouslyscanned photograph normally obtained at initial user data entry. Thesystem proceeds to identify the user and load the appropriate data, suchas the user profile and prior use history. After confirming useridentity and loading the appropriate data, the system commences asession. The system will either Initialize (if the user has used thesystem before) or Assess (if the user is using the system for the firsttime). Subsequently, the system will proceed to user stimulation(further discussed below).

Throughout this session, the stimulation process will include multitudesof various events types which include but are not limited to: DemoQ(demographic questionnaire), Login (user authentication), Main Title (anA/V presentation that displays every session, typically just after thelogin event), Volume-Adj (a series of screens to allow the user toadjust the volume of the speakers or headphones to their preferredlevel), Orientation (a quick A/V review of how to use the invention),Review (an A/V of high points from the users last Session 202), News (anevent presenting something involving current news), Question (an eventpresented in question format, requiring a single response), Story (anevent presented in story format, which may involve multiple userstimulus/response interactions), Puzzle (an event that acts like awell-known puzzle format, like Tic-Tac-Toe), Phys Ed (an event designedto lead the user through physical exercises), Motivation (an A/Vpresentation designed to improve the users outlook or motivate theuser), Entertainment (an A/V presentation just for fun).

There are a variety of sources of stimulation the system selectivelyuses that include a variety of events (based on, but not limited to fineart, historical events, pop culture, inspirational messages, exerciseactivities, meditation activities, and spiritual activities). Thesessions may include certain special events, such as an ending event orevents including a teaser/preview/cliffhanger for motivation for theuser to return, and a starting event or events involving the promisedactivity/exercise from the teaser/preview. The system may present userpersonal items such as addressing the user by their name, acknowledgingtheir birthday, and/or an inclusion of events that have user specificphotos, sound bites, home movies/videos of user/family activities thatinclude family and friends or with places and/or events user ispersonally familiar with, and questions relating to stored user data (asan example, “how old were you in 1952?). There may be questions thatcould: be in a multiple choice form; involve events that include movieand music clips, sound effects; involve “radio theater” style vignettes;include “rewards” for getting “correct answers, that include movie andmusic clips, trivia, fun facts, photos; and involve character voices tohelp illustrate concepts. There also may be a voice over announcer orhost to: present the stimulus to the user simultaneously with the onscreen (written in type) stimulus; provide positive, directional, orcorrectional responses to user input; provide what appears to berandomized feedback responses to users using a “round robin process,”;prompt users to take a guess if there is a pause or interval without aresponse; and provide time orientation.

The system described herein, provides other types of auditory feedback,such as escalating “dings” for “correct” responses. Cognitive domainsexercised by such stimulation includes but are not limited to Short TermMemory/Delayed Recall, Long Term Memory, Language, Visual (includesvisuospatial and visuoperceptive), Critical Thinking (includes Conceptformation, sorting, patterns, logic/reasoning, planning, flexibility),and Mathematical. In an institutional setting, an administrator maychoose session duration (typically 30-45-minutes, based on schedulingrequirements). An embodiment of the invention will adjust the session(events 204) to match the chosen duration independently of theapplication of the rules, which determine Event sequence. This shallgive the user a sense that there is a beginning (a ramp up, easierevents to start), middle (a break, particular events), and end to eachsession. The user will then feel as if he/she has “completed” a session,rather than experiencing an abrupt interruption or a forced ending.

After completion of a session, the system stores all the data it hasattained to analyze for future interactions with the user. The systemprovides reports and any important alerts regarding the user'sperformance to caregivers, physicians and family members involved withthe user's well being. In the event that a user is in communication withan institutional system installation by means of an internet connection,the user system and the home base server can exchange information, whichallows the home base server to analyze the user data, upload newcontent, upgrade software, and diagnose any possible problems with thedevice. While the system can operate standalone, the default function ofthe system is to cease operation if the system has not communicated withthe home base server for longer than two (2) days. For environments suchas retirement and senior care communities where multiple systems are inoperation, an alternative manner of downloading content or other similartypes of communication with the home base server may ensue. Among thedevices in that location that are connected to their facilities'network, the devices will choose one of them to be the “master,” whichcan change each time such a communication is made. This “master,” willbe the first to download the content, and then through the facilities'network spread that download or similar communication to the rest of thesystems. Upon starting a new session, as mentioned above, the devicewill remember past interactions with the user, and continue to buildupon the user's profile to better conform to the user's needs and ensuremaximum stimulation.

Software

FIG. 3 illustrates a very basic overview of a Session 202. First at step300, a session begins. If this is the first session for the user, thenthe system will continue with step 302 Assessment, depicted in detail inFIG. 4 described below. If this is not the first session the user hadexperienced with the system, then the system will instead start step 304Initialize, depicted in detail in FIG. 5 also described below. After theassessment or initialization, the device will continue with step 306Stimulate, further described below.

FIG. 4 illustrates the steps taken in an Assessment (step 302), theoperation that occurs when a new user starts a new show. At first step400 the system collects the user's baseline demographic information fromthe User Demographic Database 108. The system at step 402 determines theuser's baseline mental status. In determining the user's baseline mentalstatus, Stimulator 100 performs a process identical to step 400, butdoes so using events from the event database 112. After the user'sbaseline mental status is determined, the system at step 404 creates acognitive profile record. It also records the same mental statusdetermined in step 402, in a User Cognitive Profile database 116. Thedevice uses the single baseline in all the user's cognitive profilerecords as a starting point for selecting events from the Event Database112 of appropriate difficulty to present to the user during eachSession. After the starting point is determined, the system will proceedwith stimulating the user.

FIG. 5 illustrates the steps taken in an Initialization procedure 304,the operation that occurs when a user who has used the device before,starts a new session. This operation retrieves from databases 108, 116,124 and 138 all information necessary to conduct a current session 202in a manner informed by user data stored by stimulator 100 in previoussessions 202s. At step 500 the system reads the show rules pertinent tothe show to be presented. The show rules are organized to properlyconduct a presentation through the events and screens to be utilized.

At step 502, the system reads the user's demographic profile from theUser Demographic Profile database 108. At step 504 the system reads theuser's Last-Show environment, by retrieving the user's information fromthe User's Last-Show Environment Database 124, as well as counters(further explained in the Next Rule to Apply section below) reflectingthe number of Events 204 that have occurred since the last presentationof Events in each of the cognitive domains. This exercise ensures thatrepetitive and in some cases, non-suitable events, due to either ease ordifficulty or complexity, are not presented in a current show.Accordingly, both the challenge level and interest level to the user ismaintained at a value proper for the current user. At step 506, thesystem initializes the user's current show environment and proceeds withstimulating the user.

For processing the large number of possible events to provide cognitivestimulation for the user, an embodiment of the system has a set of“event rules.” The event rules determine both the sequence and manner inwhich way the Sessions and Events are presented to each user. Instead of“pre-programming” the Sessions and Events (which may give a sense ofrepetitiveness and not properly address the users interests, needs, norprovide needed day-to-day variations in cognitive ability), the systemuses an “adaptive response” technique embodying a concept named, “thenext rule to apply” which is discussed further below. A novel aspect ofan embodiment of the present invention is that the adaptive responsetechnique makes each session unique for each user, every time it isused.

The steps involved in determining the sequence of event occurrence andinteraction with the user is shown in FIG. 6. Upon the start of thecognitive stimulation process at step 601, the stimulation may continuefor the length of the predetermined duration (DUR) of the session atstep 602. After the desired session duration is reached, cognitivestimulation ends at step 603. If the current duration time is less thanthe desired duration time, the system determines the next rule to applyat step 604. Next, the system uses the determined rule from the previousstep to determine the next event to show (606). Each event has a certainnumber of event screens, and so that event comes with a starting eventcount above 0, and as the event progresses the number starts to countdown as each event screen is presented. After determining the rule to beused, the system presents the screens to the user until the Event ScreenCount (SC) reaches zero at step 608 which is reached after the systempresents the final screen 206 of the event 204 (see FIG. 2). Eachdifferent event has an associated screen count which represents thenumber of different screens contained within the particular event. Thescreen count number depends upon and varies as a function of the type,complexity and objective of the event currently being presented.

The system then evaluates the user's responses and, if appropriate,changes the value stored in the User Cognitive Profile database 108 forthe current user and the current event 204's primary cognitive domain(part of the self adjustment function) in step 610. If the screen countsare above zero, the device will continue to show the user the nextscreen in the event in step 614. These screens will display a screen 206of event 204, which includes giving a query and displaying buttons forthe user to contact to receive the user's response. Depending on thetype of screen and event, the screen will continue to be shown to theuser until the button number (B) equals 0, or the “correct” button hasbeen pressed in step 616. After the button number (B) reaches 0, or the“correct” button has been chosen, the system then stores the responsetime and the number of attempts necessary to get a “correct” responsefor each Screen 206 of the current event 204 in step 618. In theinstance that the number of buttons is greater than 0, or is the“incorrect,” button, the system decreases the complexity of the stimulusat 618 in each stimulus-response possibility on each screen 206 fromwhich the user can choose, or provide a verbal or visual hint, or bothat step 622. The device receives the user's input at step 620, for eachstimulus-response possibility on each screen 206 of event 204, and thengives the user encouraging feedback after each response at step 622based on his or her response and the results are recorded at step 624.

Rules and Events

A salient feature of an embodiment of the present system is itsrule-based procedure for determining what content the user is presented,and the time of presentation. The rule-based procedure by which anembodiment of the present invention chooses content for a user reliesupon rules regarding the characteristics of the content to be shown tousers, rather than identifying the exact content to be seen by eachuser. In addition, the procedure ensures that users will not see contentinapplicable to them, and allows session times to be of any length,since the content at specific percentages of the session time may bespecified.

The rules are an important tool for controlling each user's experienceduring a session using the system described herein. The two main aspectsof this experience are show contour and show variability. The showcontour provides a continuum of presentations through a session in orderto provide the user with the feeling that they are smoothly proceedingfrom the beginning stage, through the middle stage to ending stage of asession, rather than just experience an abrupt start or an abrupt endwith the potential of causing some uneasiness and anxiety in the user.Show variability refers to making the show seem new and novel at alltimes in order to avoid giving the user a sense of repetitiveness inevent or show presentations. It is important to control the show contourbecause, as in a television episode, each user session is aself-contained episode and must have a beginning, middle, and end.Sessions of any length will contain all these elements of the showcontour. Additionally, it is important that the show be unpredictablebecause, without variability, users are likely to become bored and stopusing the system and thereby discontinue the cognitive stimulationbenefit provided by using the system.

The table below illustrates an example of rule protocol in a usersession:

Cognitive Level of Minimum Sequence Rule # Domain Functioning FrequencyNumber 1 Long term Normal High One per 5 1 memory (L1) events 2 Longterm Mild Cognitive One per 5 2 memory Impairment events (L4) 3 Shortterm Normal High One per 7 3 memory (L1) events 4 Short term MildCognitive One per 7 4 memory Impairment events (L4)

The rules are chosen based on the user's cognitive profile and last showenvironment. In this example, if the user is high-functioning (L1), theneither rule 1 or 3 will apply. The system then attempts to choose a rulebased on the minimum frequency specified. If the user has not seen along-term memory event in the last 6 events, and has not seen ashort-term memory event in the last 8 events, then again, both rules 1and 3 qualify because the user has not met the minimum frequencyrequirements for both rules. In this case, the sequence numberdetermines which rule is used next. Since rule 1 has a lower sequencenumber than rule 3, rule 1 is the rule chosen.

Once rule 1 is selected, it will guide the system in choosing the nextevent to show the user. Rule 1 requires the system to look in the eventsdatabase for an event that exercises the cognitive domain of long termmemory. The event must also be at a high difficulty level, since therule chosen indicates that the user's level of functioning is high.Finally, the event must match the user's demographics, as collected inthe initial questionnaire. In a similar fashion, if the user level offunctioning is mild cognitive impairment (L4), then either rule 2 or 4will apply and since rule 2 has a lower sequence number than rule 4,rule 2 is chosen. The selection of an event according to rule 2 thenfollows with the above considerations, relating however, to mildcognitive impairment rather normal high.

To explain the way in which the rules accomplish their purposes, it isimportant to discuss the organization of the content seen by the user. Ashow consists of self-contained building blocks called events, which maybe of varying lengths and complexity; they are strung together,bead-like, according to the Rules. Events are organized in a hierarchythat includes Domains, event types, and event subtypes. Domains are thecognitive domains familiar to neuropsychologists, such as Long-TermMemory, Short-Term Memory, Language, Visuospatial skills, and twosub-domains of Executive function, Critical thinking and Calculation.There are also specific domains that serve to organize the content notcorresponding to familiar cognitive domains. These unique domainsinclude such categories that may be designated as “Spirit and Soul” and“The Center,” a group of exercises that serve to relax and focus theuser.

Each domain has several associated event types, which are higher-levelgroupings of events within the domain. For example, the Short-TermMemory domain has an event type called “Lists.” Each event type, inturn, has several associated event subtypes, lower-level groupings ofevents within the event type. For example, in an event type identifiedas a “List”, there is an event subtype called “Word Lists.” Each eventsubtype is associated with one event type, and each event type isassociated with one domain. With regard to the example above, the listidentifies the category of the event type, and “word” as distinct fromnumbers as symbols, for example, defines the nature of the content ofthe “List”. Another possible example of an event subtype, is “Tom'sGrocery List.”

Events are further categorized by Special Interest Area (SIA). When theusers start their first session, they choose from a list of SIA's andindicate which ones they especially like or dislike. The rules ensurethat the users do not see events in SIA's they do not like, and see ahigher percentage of events in SIA's they do like. SIA's may includehistory, music, sports and pop culture as mere examples.

The two main purposes of the Rules, however, as discussed above, are tocontrol the contour of the show and provide variation. As mentionedpreviously, providing show “contour” provides the user with a sense of a“beginning,” a “middle,” and an “end,” so the user doesn't feel that hisshow had abruptly started and ended. Providing variation is alsoimportant to ensure that the user doesn't get bored with constantrepeated events, and encourages repeated use. There are two rule typesnecessary to accomplish these two purposes. The first rule type is theTemporal Rule type; temporal rules specify which types of events will beseen at different time periods in each session. All the rules, includingthe temporal rules, tend to customize the presentation to the currentuser. The events identified by the temporal rules serve to orient theuser at the beginning of each session and to end the session on apositive note. The second rule type is the Frequency Rule type;frequency rules specify how often a user will see a given type of event.Because these frequency rules control the minimum and maximumfrequencies of event types, users will see a large range of differentevent types in a varied fashion.

It is desirable to further control the show contour by followingdifficult events with easier ones, or by following long events withshorter ones. This enforces variability in difficulty and rewards usersfor completing long or difficult events. To accomplish this, a thirdtype of rule is necessary, defined as the post event subtype (PEST)rules. PEST rules specify event subtypes to follow other event subtypes.In most cases, the leading event subtype is a challenging, highlycognitively stimulating event, and the post event subtype is a rewardingevent that involves reminiscence of music or film clips.

Each rule and event has various values associated with them. Some have“count” values (which can be defined in varying ways such as being theminimum amount of events needed before being implemented), oridentifying “serial numbers,” (an internal indicia identifying aspecific user or event) or similar distinguishing indicia. Depending onthe situation, these values are used by the system in different ways toeither sort by their values, or make a choice among several choicesdepending on their counts.

Determining the Next Rule to Apply (Step 604, FIG. 7)

To further explain the procedure of determining the Next Rule to Apply,references is made to FIG. 7 which outlines the steps taken in step 604,“Determine Next Rule to Apply.” With further reference to FIG. 10,determining the next rule to apply would take place before each event,that is, between FIG. 10G and FIG. 10H, and between FIG. 10J and FIG.10K, and between FIG. 10L and FIG. 10M, and between FIG. 10S and FIG.10T, and between FIG. 10X and FIG. 10Y, and between FIG. 10Y and FIG.10Z, for example. As described above, each rule associated with certainevents has a “Minimum-Starting-Event-Count” value. The“Minimum-Starting-Event-Count” means that the rule will not be appliedif the total number of event's the user has been presented is less thanthe event count value that the rule has been given. Additionally, as theuser continually uses the system, the system counts the number of eventsthey've experienced and totals it into a “Total-Event-Count.” The“Total-Event-Count,” is the number of events the user has seenthroughout an entire show.

In block 702, the system reads the “Total-Event-Count”, and eliminatesfrom current contention all other rules withMinimum-Starting-Event-Counts that are higher than that“Total-Event-Count.” These higher-numbered events may not yet beappropriate for the user to experience, so eliminates those as choicesof events to show the user. In the same fashion as the previous step,the system then eliminates from the current contention all rules with aNumber-of-Events-Since-Last-Rule-Application-Count less than the Rule'sMinimum-Occurrence-Count in block 704, resulting in providingsignificant variability. Next in block 706 the system goes through afinal elimination process, by eliminating from current contention allrules whose group level doesn't match the user's level in the domain towhich the rule applies.

The system then proceeds through a rule sorting phase, sorting theremaining rules by (number of events since the last applicationcount)-(the rule's maximum number of events since last) in block 708, indescending order. The rule's number of events since the last applicationcount indicates the number of events that have occurred since the lasttime that event category has been used, and the rule's maximum number ofevents since last value indicates the number of events that should occurbetween two events that are of the same subtype. Then a sort of rules bytheir “minimum number of events since last” in ascending order in block710 is performed. This value indicates the minimum number of events thatshould occur between two events of the same subtype. Then a sort ofrules by their sequence number (numbers that indicate a general order,the lower the number of the event means the more likely it will be seenfirst than other events with higher numbers) in ascending order in block712 is performed. Finally, the system applies the first rule in theremaining set in block 714 from the rules sorted in blocks 708-712according to the priority they have been given.

After the system chooses the next rule to apply, the system uses it todetermine the next event to apply. Depending on the rule chosen, thesystem will go through the Events Database (112), match information fromthe User Demographic Database (108) and the User Cognitive Database(116), and sort through the events several times before picking theappropriate events. These steps are further described below.

Determining the Next Event to Apply (Step 606, FIG. 8)

To further explain the Next Event to Apply, reference is made to FIG. 8which outlines the steps taken in step 606, “Determine Next Event toApply.” With further reference to FIG. 10, determining the Next Event toApply would take place before each event that is between FIG. 10G andFIG. 10H, between FIG. 10J and FIG. 10K, between FIG. 10L and FIG. 10M,between FIG. 10S and FIG. 10T, between FIG. 10X and FIG. 10Y and betweenFIG. 10Y and FIG. 10Z, for example. Depending on the rule determined inthe step above, the system may determine the next event in varying ways,but each follows the same basic steps. In block 802, for the eventcategory associated with the next rule to apply determined previously,the system retrieves from the User Cognitive Profile Database (116) theuser's current cognitive stage, that is, the present level of the user'scognitive ability and “Last Event Seen serial number.” This “Last EventSeen serial number” is the term that is used for the last event the userhas seen, to track the user's progress and to ensure variability of theevents the user sees to avoid repetitiveness.

As the user uses the system and interacts with the events, the lastevent the user has seen is noted in the User Cognitive Profile Database(116), which is termed the “Last Event Seen serial number.” Next, forthe event category associated with the next rule to apply, the systemdetermines the user's awareness era from the user's birth date plus tenyears through the current date and the user's cognitive stage, in block804. Depending on the Mental Status of the user, it may vary, typicallydecreasing at higher stages. At Stage 1, it may begin at the user's dateof birth plus 15 years, ending at the present day. Stage 2 it may beginat user's date-of-birth plus 15 years and end 40 yrs later (age 55). Atstage 3 it may begin at user's date-of-birth plus 15 yrs and end 20 yrslater (age 35). At stage 4 it may begin at user's date-of-birth plus 15yrs and end 10 yrs later (age 25). Finally, with step 806 the systemgets the next event that matches: the event category determinedassociated with the determined rule; the language, culture, and genderof the user retrieved from the User Demographic Database (108); theawareness era (previously calculated); the user's level for the eventcategory's domain (retrieved from the User Cognitive Profile Database(116)); the user's special interest areas retrieved from the UserDemographic Database (108); with the first serial number greater thanthe high-watermark serial number retrieved in step 802. Once the systemfinds the Next Event to Apply, the system presents the event to the userat the user's level in the particular event's domain.

Evaluation of User Responses and Adjustment of Difficulty Level, ifAppropriate (step 610)

To be effective, a cognitive stimulation system presents users with anoptimum level of challenge. This is true for the following reasons: ifthe challenge is too great, the user will experience frustration; if thesystem is not challenging enough, the user will be bored. In eithercase, the user will likely lose interest in using the system—andtherefore no longer receive the benefits of mental stimulation thesystem provides.

The system self-adjusts to provide users with the optimum level ofchallenge, as follows: As the user plays the system, it evaluates theuser's responses to questions. Based on how many incorrect responses theuser makes before choosing the correct response, the system determinesif the difficulty level is too high or low for the user, and adjustsaccordingly. This enables the system to customize the stimulation to theuser's individual level of cognitive ability, mitigating the risks ofuser frustration and boredom.

The system self-adjusts independently for each user in each cognitivedomain. This reflects the fact that cognitive functioning varies acrossdomains for each individual, and that cognitive decline may take placeat varying rates within each domain. With independent self-adjustment ineach domain, each user can be at a different difficulty level in eachdomain, and the user's level in each domain can change independently,further mitigating the risks of user frustration and boredom.

There are specific criteria for the system to change the user's level ina domain. These are outlined in FIG. 11 and explained below. Each time auser responds to a given screen, this procedure starts at block 1102 andgoes through a series of queries to see whether it's appropriate toadjust the user's difficulty level. Block 1102 evaluates results for agiven screen and adjust the user's stage (user's cognitive level), ifappropriate.

Increasing the Difficulty Level in a Domain

If, in one domain, the user answers a selected number of questions in arow correctly (five questions, for example) on the first attempt, theuser will subsequently see more difficult content in that domain. Ofcourse, the presentation of more difficult content is not to beperceived as a penalty, but rather a further challenge to enhancethought process and a feeling of accomplishment and reward for the user.This also indicates competency and/or sufficiency of cognitive ability.In FIG. 11, block 1104, the system evaluates whether the user hadresponded correctly on the first attempt. If so, the system in block1112, continues to count the number of consecutive screens in thescreen's domain where the user had responded correctly on the firstattempt. If that number is below selected number, typically five, theprocess ends. If however the number is above another selected number,typically four, the system continues to block 1120 and raises thedifficulty level. If the user does not answer correctly on the firstattempt, the system will continue to block 1106 and evaluate whether theuser had “failed” the screen.

Decreasing the Difficulty Level in a Domain

Two situations will cause the system to show easier content to the user.Both rely on the concept of a failed screen, indicative of a user'sfailure to successfully select the “correct” response in the mannerdescribed below.

Screen Failure (block 1106)

A screen is considered failed if it exhibits the following combinationsof screen attributes and user responses. If the screen is consideredfailed in any of the following cases, the system will continue to block1108 and count the number of failed screens in that screen's domain:

1) The screen has only one correct response and the user makes at leasttwo incorrect responses before arriving at the correct response.

2) The screen has multiple correct responses that do not have a specificsequence order and the user's number of incorrect responses beforechoosing all the correct responses is greater than or equal totwo-thirds of the number of incorrect responses on the screen.

3) The screen has multiple correct responses that do have a specificsequence order and does not have buttons that are not in the sequence,and the user's number of out-of-sequence responses before arriving atthe correct sequence is greater than or equal to two-thirds of thenumber of buttons on the screen.

4) The screen has multiple correct responses that do have a specificsequence order, does have buttons that are not in the sequence, and doesnot display a virtual keyboard or in the instance that the user's numberof incorrect or out-of-sequence responses, before arriving at thecorrect sequence, is greater than or equal a predetermined percentage(preferably two-thirds) of the number of buttons on the screen. However,each response that is correct but out of sequence is multiplied by apredetermined percentage (preferably one-half) before beginning thiscalculation.

5) The screen displays a virtual keyboard; the user is required to spella word that is the correct response, and the user has spelled at leasttwo incorrect words before arriving at the correct word.

Decreasing the Difficulty in One Domain

The first situation that results in decreased difficulty of content seenby the user decreases the difficulty level in only one domain. Thesystem will show easier content in a domain if the user has failed threescreens in the domain. Experience has shown that three screen failuresis the threshold for frustration in most users and the point at whichusers want to see easier content. In FIG. 11 block 1108, if the numberof failed screens is above 2, the system moves on to block 1110 anddecreases the difficulty level in that one domain.

No Screen Failure

If however none of the situations apply and there is no screen failure,the system moves to block 1122. It would be not be appropriate for thesystem to decrease the difficulty level of content merely because theuser had simply been careless on a few screens, or had difficulty withone isolated subject in the domain, that is, if the user's three failedscreens were an anomaly. To account for this possibility, the systemprovides a way to nullify failed screens. If the user does not fail onfour consecutive screens in a domain, the system subtracts one from thenumber of screen failures in the domain seen in block 1124. The logicbehind this is that, if a failure is truly an anomaly, then the usermust prove this by performing above the failure threshold on multiplescreens in succession. Otherwise, the process ends. The system alsocontemplates a special case where in the event an adjustment has beenmade by way of improvement from L4 or L5 and a single screen failurewithin the next three screen in the applicable domain occurs, the userwill immediately returned from L3 to L4 or from L4 to L5 as the case maybe. The rationale for the readjustment is to ensure that a user whoshould realistically be at L4 or L5 but who responds correctly andconsecutively to several queries in L4 or L5, isn't elevated to L3 or L4as the case may be, and left there inappropriately, but is quicklyreturned to the easier level (L's) after rapid subsequent failures.

Decreasing the Difficulty in all Domains

To account for the instance when three consecutive screen failures inone domain are followed by three failures in subsequent consecutivedomains potentially resulting in 18 consecutive screen failures over sixdomains, the system has an override feature that will drop thedifficulty level in all domains if the user has failed at least fivescreens in a row across at least three domains. Such a pattern offailures indicates the user is having a multi-domain decrement infunctioning. This may be the result of the normal day-to-day fluctuationin mental acuity frequently seen in demented users, or it may be theresult of a more serious medical problem, such as a small stroke. Ineither case, the system will accommodate the user by decreasing thedifficulty level of all content shown to the user. Accordingly, thesystem in block 1108 counts the number of failed screens and if greaterthan three, the system moves to block 1114 and counts the number ofconsecutive failed screens. If the number of failed screens is belowfive, the difficulty level remains unchanged. If instead the number isabove 4, then the system counts the number of different domains in whichthe user failed consecutively in block 1116. If the number of faileddomains is less than three, the difficulty level remains unchanged. Ifhowever the number is above 2, then the system decreases the difficultylevel in all domains in block 1118.

Interface Design, Apparatus and System

As mentioned above the device uses a touch screen interface 126A toovercome any technological barrier the user may have. The interface 126Amay also include a camera 131 used at least for identifying the user.The events have a button/answer/input control that will either:disappear when a “correct” choice is made; use pictures, words, ornumbers to display choices; and other possible mediums to interact withthe user. This on-screen control can display further answers, and serveas an input device for user responses. The screen can also display anon-screen calendar for date orientation. Audio interface may be providedby a standard speaker 126B with accompanying electronics 950.

As described for FIG. 1 and in further detail in FIG. 9, the device iscomposed of integrated hardware and software. The show rules data base104, the events data base 120, the screens data base 120, the userresponse data base 132, the user demographic profile data base 108, theuser cognitive data base 116 and the user last show environment database 112 may be contained in a commercially available digital storagemedium. The stimulator 100 and analyzer 136 may be implemented in memoryunits known to those skilled in the art. As described above, through anInternet connection the system through networking circuitry 930, canupdate or download content and upload user performance. Complex datamanipulation and control processes may be undertaken in commerciallyavailable or specially designed central processing units 902. Also thedevice can provide reports and any important alerts regarding the user'sperformance to caregivers, physicians and family members. The device canbe set up to function in a user's home, medical facility, senior carecommunity, community center, therapeutic center, senior day care centerand any similar area.

The descriptions of the invention, the specific details, and thedrawings mentioned above, are not meant to limit the scope of thepresent invention. The present invention may be embodied in otherspecific forms without departing from its spirit or essentialcharacteristics. The described embodiments are to be considered in allrespects only as illustrative and not restrictive. The scope of theinvention is, therefore, indicated by the appended claims rather than bythe foregoing description. All changes, which come within the meaningand range of equivalency of the claims, are to be embraced within theirscope.

1. A method for providing adaptive rule based cognitive stimulation to auser, comprising the steps of: providing a query to identify a user;providing the identified users demographic data from a demographic database; providing the user's cognitive profile based upon the user'sdemographic data; establishing a stimulation protocol based upon ahierarchy of predefined rules and the user's cognitive profile;providing a stimulus based upon the stimulation protocol; evaluating theresponse to the stimulus; and providing user feedback indicative of theevaluated response.
 2. The method of claim 1 wherein the step ofproviding a query to identify a user comprises the steps of: taking acurrent photograph of the user; utilizing a biometric identificationprocess for comparing the current photograph with a stored inventory ofuser photographs; and requesting confirmation in the event that asuccessful photograph comparison occurs.
 3. The method of claim 2further comprising the step of repeating the steps of claim 2 no greaterthan a pre-determined number of times or until a successful photographmatch occurs, which ever comes first.
 4. The method of claim 3 furthercomprising, utilizing a keyboard, the step of providing useridentification in the event that no successful photograph occurs.
 5. Themethod of claim 1 comprising utilizing at least the user's name, birthdate, country of origin, first and subsequent languages spoken,residence history, hobbies, vacation history, interest areas, familymember names and relationship to the user, vision and hearinglimitations, if any, in providing the users demographic data.
 6. Themethod of claim 5 further comprising the step of updating the user'scognitive profile based upon the users response for the stimulus.
 7. Themethod of claim 6, wherein the step of providing a stimulus comprisesthe step of providing interactive presentations in a predeterminedhierarchy comprising the steps of: presenting a show; presenting atleast one session contained within the show; and presenting at least oneevent contained within the session, said show comprising the sessionspresented in at least one complete performance of said method, saidsession comprising all the events presented in a single completeperformance of said method, said session utilizing the users cognitiveprofile updated based upon user past responses to stimuli, said eventcomprising at least one user stimulus-response interaction for at leastmaintaining and improving the user's cognitive profile.
 8. The method ofclaim 7 wherein the step of presenting an event comprises the step ofutilizing a screen for visual interface with the user and utilizingspeakers or headphones for audible interface with the user.
 9. Themethod of claim 7 wherein the step of presenting an event comprisespresenting a stimulus selected from the group consisting of: providing ademographic questionnaire, providing orientation on use of the method,providing an audio/visual presentation on the level of success from theusers last performance of the method, providing information regardingcurrent events, providing a query requiring a single response; providingan event in story format involving at least one stimulus-responseinteraction; providing an event in a puzzle format for user solution;providing an event designed to lead a user through physical exercises;providing an audio/visual presentation for improving the users state ofmind, outlook, disposition or motivation; and an audio/visualpresentation for solely entertainment purposes.
 10. The method of claim9 further comprising the step of: presenting at least one selectablecategory, each category representing different subject matter,presenting an audio/visual presentation related to the selectedcategory; presenting a plurality of queries related to the audio/visualpresentation, said queries posing interrogative expressions related tosaid audio/visual presentation, said interrogative expressions having alevel of difficulty based upon the user's cognitive profile, evaluatingthe response to the query; acknowledging success in the selection of thecorrect interrogative expression; and requesting an alternate selectionof an interrogative expression in the event of the selection of anincorrect expression.
 11. The method of claim 10 further comprising thestep of removing the selected incorrect interrogative expression fromavailable choices until either only the correct interrogative expressionremains or the correct interrogative expression has been selected,whichever occurs first.
 12. The method of claim 10, further comprisingthe step of adjusting the user's cognitive profile as a function of thelevel of success in the selection of the correct interrogativeexpressions.
 13. The method of claim 10 further comprising the steps of:measuring the time difference between the occurrence of presenting thequeries and the response thereto; comparing said time difference to apredetermined value; prompting a response upon the occurrence of thepredetermined value; after a predetermined time, issuing a subsequentprompt upon the failure of responding to a prior prompt; and repeatingissuing a subsequent prompt and terminating the current presentationafter a predetermined number of prompts.
 14. The method of claim 13further comprising the step of providing a different presentation uponthe termination of the current presentation.
 15. The method of claim 13further comprising the step of providing a less difficult presentationupon the termination of the current presentation.
 16. The method ofclaim 10 further comprising the step of increasing the level ofchallenge of the queries in a presentation upon the successful selectionof all interrogative expressions in such presentation within apredetermined length of time.
 17. The method of claim 16 furthercomprising the step of updating the user's cognitive profile based uponthe successful selection of all interrogative expressions in suchpresentation within a predetermined length of time.
 18. The method ofclaim 16 further comprising the step of selecting subsequentpresentations in accordance with the user's updated cognitive profile.19. The method of claim 10 wherein the step of acknowledging includesthe step of providing an audio or visual presentation havingnon-challenging entertainment and positive feedback value as a rewardfor successful user performance.
 20. The method of claim 10 wherein thestep of evaluating further comprises the step of determining whethersaid responses are consistent with the user's current cognitive profileand providing an alert in the event that it is determined that saidresponses are indicative of a decline in a user's performance greaterthan a predetermined amount.
 21. The method of claim 20 furthercomprising the step of providing the alert to a remote observer.
 22. Amethod of providing adaptive rule based cognitive stimulation during astimulation session to a user having cognitive profiles defined for aplurality of cognitive domains, said stimulation session comprising atleast one event contained within the session, a cognitive domaincontained within the event, at least one event type contained within thecognitive domain and at least one event subtype contained within the atleast one event type, said method comprising the steps of: selecting anevent, an event type and an event subtype in accordance with a pluralityof predefined rules in a hierarchy; and establishing a stimulationprotocol based upon the hierarchy of predefined rules and the userscognitive profile.
 23. The method of claim 22 further comprising thestep of selecting a cognitive domain from the group consisting of: longterm memory, short term memory, language, visuospatial skills andcritical thinking.
 24. The method of claim 22 wherein said at least oneevent is related to a specific selectable special interest area (SIA)such that selection of an SIA precludes cognitive stimulation in areasother than the selected SIA.
 25. The method of claim 22 furthercomprising the step of utilizing at least one temporal rule configuredfor selecting the event types and the times of occurrence thereof duringa stimulation session.
 26. The method of claim 25 wherein the steputilizing said temporal rules further comprises the steps of: providingorientation to the user regarding the selected event types; andproviding positive reinforcement to the user at the termination of astimulation session.
 27. The method of claim 22 further comprising thestep of utilizing at lest one frequency rule configured for selectingthe number of occurrences of each event type during a stimulationsession, providing thereby a plurality of different event typespresented in varying order.
 28. The method of claim 22 furthercomprising the step of utilizing at least one post event subtype (PEST)rule configured for specifying a subsequent event subtype following thepresentation of a prior event subtype.
 29. The method of claim 28wherein, following a challenging cognitively stimulating event subtype,the step of specifying a subsequent event subtype comprises the step ofselecting a rewarding event comprising reminiscence selected from thegroup consisting of music, film clips, congratulatory presentations andencouragement presentations.
 30. The method of claim 28, wherein eachrule associated with an event includes a minimum starting event count(MSEC) value and wherein a total event count (TEC) comprises the numberof events presented to a user in a session, further comprising the stepof eliminating from contention for application, all rules with a MSECgreater than the TEC.
 31. The method of claim 30, wherein each ruleassociated with an event includes a number of events since a last ruleapplication (NESLRA) count and wherein a rules minimum occurrence (RMO)count comprises a minimum number of rules applied, further comprisingthe step of eliminating from contention for application all rules with aRMO count greater than the NESLRA count.
 32. The method of claim 31further comprising the step of eliminating from contention forapplication all rules designating events whose difficulty level is notcommensurate with the user's current cognitive profile.
 33. The methodof claim 32 further comprising the step of sorting rules not eliminatedfrom contention for application comprising: sorting in descending order,the rules by NESLRA; sorting in ascending order, the rules by RMO;sorting in ascending order by sequence number, the rules in a sequence,identified by such sequence number; and applying the first ruledetermined from said ordered sort, to identify a next event forpresentation.
 34. The method of claim 33, wherein identifying the nextevent to be presented further comprises the steps of: utilizing theuser's current level of cognitive ability; utilizing the last eventpresented to the user; and utilizing the user's demographic profile andSIA.
 35. A method of providing adaptive rule based cognitive stimulationduring a stimulation session to a user having cognitive profiles definedfor a plurality of cognitive domains, said stimulation sessioncomprising a plurality events contained within a session, said pluralityof events being presented to a user in a sequence established by saidrules, said events including at least one query, wherein for each domainsaid method comprises the steps of: presenting a plurality of queries toa user for response thereby; evaluating the number of correct andincorrect responses to said queries; based upon said evaluation,determining the level of difficulty of said queries; and adjusting thelevel of difficulty of subsequent queries as a function of saidevaluation.
 36. The method of claim 35 further comprising the step ofincreasing the level of difficulty of a subsequent query upon theoccurrence of a consecutive number of correct responses being equal to apredetermined number.
 37. The method of claim 35 further comprising thestep of decreasing the level of difficulty of a subsequent query uponthe occurrence of a number of incorrect responses being equal to apredetermined number.
 38. The method of claim 37 further comprising thestep of reducing the number of incorrect responses by one upon theoccurrence of the number of consecutive correct responses being equal toa predetermined number.
 39. The method of claim 37 further comprisingthe step of reducing the level of difficulty of queries in all domainsupon the occurrence of the number of incorrect responses in apredetermined number of domains being equal to a predetermined number.40. The method of claim 37 further comprising the step of increasing thelevel of difficulty of queries in all domains upon the occurrence of thenumber of correct responses in a predetermined number of domains beingequal to a predetermined number.
 41. The method of claim 35, whereinsaid cognitive profiles define an initial cognitive ability of saiduser, said method further comprising the step of adjusting the cognitiveability of said user in accordance with the evaluation of the user'sresponses to said queries.
 42. A system for providing adaptive rulebased cognitive stimulation to a user comprising: a stimulation deviceadapted to present a plurality of queries to the user, said querieshaving an initial level of difficulty in a selected cognitive domain; aresponse device adapted to receive the user's responses to said queries;an evaluation device adapted to evaluate the user's responses to saidqueries, said evaluation device further adapted to adjust the level ofdifficulty of said queries commensurate with the user's cognitiveability; and audio/visual interactive display means for presentingqueries to and receiving responses from said user.
 43. The system ofclaim 42 wherein said stimulation device establishes the initial levelof query difficulty and an initial cognitive ability of the user. 44.The system of claim 43 wherein the stimulation device comprises meansfor utilizing demographic information comprising the user's birth date,gender, language, culture, education, profession, and personalpreferences, said means further utilizing the user's cognitiveinformation comprising short term memory, long term memory, calculation,visuospatial and critical thinking to establish the user's initialcognitive ability.
 45. The system of claim 44 wherein the evaluationdevice is adapted to adjust the level of difficulty of subsequentqueries in a selected cognitive domain as a function of the number andsequence of correct responses to prior queries in such selectedcognitive domain.
 46. The system of claim 45 wherein the evaluationdevice is adapted to adjust the user's cognitive ability in a selectedcognitive domain as a function of the number and sequence of correctresponses to prior queries in such selected cognitive domain.
 47. Thesystem of claim 45 wherein the evaluation device is adapted to utilize arule based protocol to adjust the level of difficulty of the queries andthe order of presentation of such queries.
 48. The system of claim 45wherein the stimulation device is adapted to provide congratulatoryfeedback to the user via said display means upon receipt of a correctresponse and conciliatory positive reinforcement and encouragement uponreceipt of an incorrect response in order to maintain and/or increasethe user's self esteem and self confidence.
 49. A system for providingrule based cognitive stimulation to a user, comprising: means fordetermining and recording the user's cognitive ability; stimulationmeans for presenting at least one query, having a level of difficulty ina cognitive domain, to said user for responses thereby; evaluation meansfor providing an evaluation of said responses relative to said at leastone query; means for adjusting the level of difficulty of subsequentqueries based upon said evaluation and the user's cognitive ability. 50.The system of claim 49 further comprising interactive display means forpresenting a query to the user and receiving the user's response to suchquery.
 51. The system of claim 49 further comprising means for utilizinga rule based protocol to adjust the level of difficulty of subsequentqueries and the order of presentation thereof commensurate with theuser's recorded cognitive ability.
 52. The system of claim 51 furthercomprising means for adjusting the user's recorded cognitive abilitybased upon the evaluation of the responses to subsequent queries. 53.The system of claim 52 wherein said stimulation means presentssubsequent queries at a level of difficulty commensurate with the user'sadjusted recorded cognitive ability.
 54. The system of claim 53 whereinsaid cognitive domain comprises a plurality of cognitive domains andwherein said stimulation means presents queries in each of saidcognitive domains commensurate with the user's cognitive ability in eachrespective one of such cognitive domains.
 55. The system of claim 49further comprising means for identifying a user commencing use of thesystem and utilizing such users last recorded cognitive ability in theevent that said user has previously used said system.
 56. The system ofclaim 55 wherein said identifying means comprises a camera for obtainingan image of the user, the system further comprising means for comparingthe image provided by said camera and a stored data base of images foridentifying the user.